Sperm are the specialised cells that are produced by men in their testes and contain the genetic material necessary to fertilise an egg and give rise to a new life.
Surgical sperm collection (SSC) is a term that collectively describes the techniques by which sperm are removed from the testicle or epididymis.
Sperm retrieved in this way often haven’t completed their maturation process and are immature. This causes a reduction in the sperm’s natural ability to penetrate the outer surface of the egg. As a result surgically collected sperm cells, when used as part of In-Vitro Fertilisation (IVF), are injected into the eggs to ensure fertilisation in a process called Intra-Cytoplasmic Sperm Injection (ICSI).
When the reason for a couple’s infertility has been found to be a lack of sperm in the fluid that is released by the man during sexual intercourse (the semen) or there is an inability by the man to ejaculate at all. Surgical collection of sperm is necessary.
SSC can be done either as an in-patient under general anaesthetic in an operating theatre or as an out-patient under local anaesthetic.
In both settings the sperm can be retrieved from either the testicle or the epididymis. Before the procedure can be done a detailed discussion of the operation must be completed with the treating doctor and informed consent obtained.
A general anaesthetic allows for a more invasive procedure in which the skin of the scrotal sac is opened allowing the epididymis or testicle to be directly operated on. The procedures done in this way are called; Micro-Epididymal Sperm Aspiration (MESA) and Testicular Sperm Extraction (TESE).
In both cases larger samples are generally obtained when compared to local anaesthetic procedures. As a result, enough sperm may be obtained for as many cycles as will be necessary to achieve a pregnancy. Furthermore, the chance of having a failed collection is reduced.
The down side is the increased expense, increased surgical and anaesthetic risk, longer recovery and greater post operative discomfort. These cases are done as day-surgery admissions with the patient expected to be discharged 2-4 hours post operatively.
The Local Anaesthetic is injected into the spermatic cord in the upper scrotum providing a nerve block to the contents of the scrotum but not to the skin. This allows for the use of needles to be passed through the skin into the epididymis (Per-Cutaneous Epididymal Aspiration or PESA) or directly into the testicle for Testicle Sperm Aspiration (TESA), using a wider bore needle.
Both these procedures are simpler, with fewer complications when compared to procedures done under general anaesthetic, but fewer sperm are obtained and often only enough for a single treatment cycle.
Surprisingly TESA may be more traumatic to the testis than a TESE depending on the underlying diagnosis because of the need for multiple passages of the needle through the substance of the testicle.
In all cases the degree of trauma caused by the procedures will be related to the degree of difficulty in finding and retrieving sperm. Surgical retrieval of sperm can involve varying degrees of intrusion, from simple percutaneous (through the skin) collection using a local anaesthetic to an open collection under general anaesthetic. Generally, the more invasive the collection technique, the greater the post-op discomfort.
Post operative pain is generally controlled with simple pain relief and 24 – 48 hours of resting, avoiding strenuous physical activity or direct testicular pressure. There may also be some initial nausea but vomiting is rare, as is admission to hospital overnight for further treatment.
The main complications of these procedures are: